Prostate cancer is a scourge for African-American men in North Carolina.
About 300 African-American men die annually of the highly treatable disease. If the mortality rate were reduced to the level of prostrate mortality among white men, 200 of those African-Americans who succumb would survive.
On the surface, lowering that rate is a matter of expanding access to medical care. And that would surely help. It’s likely no accident that the highest mortality rates coincide with the areas of the state where poverty is high and doctors are scarce. In poor and rural Northampton County, for instance, black men are nearly four times as likely as whites to die of prostate cancer, according to UNC-Chapel Hill’s Lineberger Comprehensive Cancer Center.
In a three-part series last week, correspondent Jay Price described the high rate of the disease, but doctors and other health care workers think there may be more to the spike than the effects of poverty and a lack of access to medical care. Genetics may contribute to the disease striking earlier and more aggressively than it does in white men. And there is a reluctance to be tested for a disease that lacks early symptoms and, if detected, many low-income African-American man can’t afford to have treated.
And there’s reason to skip being screened. Studies have found that prostate cancer has been overdiagnosed and too aggressively treated based on results of PSA tests that can suggest cancer where none exists. Indeed, in 2011 the U.S. Preventative Services Task Force, an independent group of health care professionals, recommended that men of all races skip the PSA test, a blood test that measures immune response as a marker of possible cancer cells.
The task force’s reasoning was that the PSA test gives too many false positives. And when prostate cancer is accurately detected, side effects from the treatment for the typically slow moving cancer can be worse than the disease. That’s especially so for men in their 70s or older who might die of other causes before the cancer becomes fatal.
But the task force’s recommendation may be ill-serving African-Americans who face a disproportionate rate of the disease and often confront fast-moving versions of it.
“The message that men get now is kind of confusing, to say the least,” said Dr. Durado Brooks, director of prostate and colorectal cancers for the American Cancer Society. “The task force simply said men shouldn’t be screened, but if you dig down in their recommendations, they note that they didn’t have enough data on black men to say anything about how screening affects them.”
Time to act
There’s enough anecdotal evidence for people like Walter Shearin, who runs a Roanoke Rapids barber shop. He pushes his customers to get checked by their doctor. Shearin survived the cancer after early detection, but he has seen many African-American men die because they didn’t think it would happen to them or they preferred not to know.
That’s turned the barber into an advocate for regular testing. “I talk with (customers) all the time, and I tell them, and some of them listen and some of them don’t,” he said.
Now it’s time for state lawmakers to listen. The prostate cancer rate is a powerful argument for expanding Medicaid under the Affordable Care Act. Thirty other states have done so, and North Carolina’s holdout is increasingly indefensible.
Medicaid currently covers mostly children, pregnant women, the elderly and disabled. Left out are low-income males who, among African-Americans, are the very population being hardest hit by early onset and aggressive forms of prostate cancer. Expansion would give low-income black men access to doctors and a way to afford treatment.
If Medicaid expansion is too much for those who run the General Assembly, the least lawmakers can do is increase funding for public health clinics and local health departments. Those clinics and programs can push for preventative measures such as changes in diet and provide free screenings that could result in more early detections.
The rate of African-American mortality from a treatable disease is a blight on North Carolina’s public health record. Removing it should be a top priority of the General Assembly.